Diclegis® is a combination drug containing two over the counter products: Doxylamine and Pyridoxine (Vitamin B 6). Both ingredients are Pregnancy Category A, which is great news for mothers-to-be who are overly worried. But patients also need to consider the price of this medication. Over the counter these two separate products cost under $20.00 for both. The AWP price of Diclegis is $570.00 for a 30-day supply. Up until this new drug came out, there has been no FDA approved medication with an indication for pregnancy related nausea and vomiting. Most recommendations have consisted of non-pharmacological therapies and then if those do not help relieve symptoms, physicians then try other pharmacological methods mentioned in the power point. Several sources representing the public have been reporting this as great news that there is finally a “new” treatment out for morning sickness. We will have to wait and see what happens when patients bring in the prescription and start finding out the costs and coverage of this medication. What will you do… recommend OTC products? Or just continue to fill the prescription for Diclegis®?
Posted by: Heather Nguyen, PharmD. Candidate 2014
Acute Cough: Dextromethorphan and Guaifenesin Not
One of the most confusing and most frequented aisles in the pharmacy is the cough and cold section. It is estimated that Americans spend about 3.6 billion dollars a year on cold and cough products, surprisingly there does not seem to be much benefit from some of the most popular OTC cold and cough medications.
The recommendations made by the American College of Chest Physicians (ACCP) for a healthy adult with a non-productive cough due to a cold the may surprise you. For patients with acute cough (less than 3 weeks in duration) due to the cold without any red flag symptoms (which would require a trip to the doctors office) there are two first line recommendations:
- The first is the combination of a 1st generation antihistamine/decongestant, the guidelines suggest brompheniramine and sustained-release pseudoephedrine (PSE). Currently, the brompheniramine and PSE combination is not longer manufactured so substitute brompheniramine with another commercially available 1st generation antihistamine and purchase a sustained-release PSE product separately. The patient has the option to take PSE during the day and the antihistamine at night.
- Use of naproxen, a commonly used NSAID is the second recommendation. Naproxen is believed to relieve cough by blocking the inflammatory mediator prostaglandin which decreases inflammation in the throat. To achieve this benefit, Naproxen should be taking on a scheduled basis.